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Koudounas G, Giannopoulos S, Houser A, Karkos C, Volteas P, Virvilis D. Basilic vein tunnel transposition versus elevation transposition for brachiobasilic arteriovenous fistula creation: A systematic review and meta-analysis. J Vasc Access 2024:11297298241226993. [PMID: 38336667 DOI: 10.1177/11297298241226993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare basilic vein tunnel transposition (BVTT) to basilic vein elevation transposition (BVET) technique for superficialization of a basilic arteriovenous fistula. This is a systematic review and meta-analysis comparing outcomes between BVTT and BVET for brachiobasilic arteriovenous fistula (AVF) creation. Primary endpoints were primary patency at several time intervals during follow-up and postoperative local complications, whereas secondary endpoints included primary assisted patency and secondary patency. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess heterogeneity. Nine eligible studies were identified, including 543 patients (247 in the BVTT group and 296 in the BVET group). BVTT group was associated with inferior primary patency rate at 6 months compared to BVET group (three studies; OR: 0.43; 95% CI: 0.22-0.83; I2 = 0%; p = 0.012). However, primary patency rates were similar between the two study groups at 12 months (six studies; OR: 0.64; 95% CI: 0.33-1.22; I2 = 40.7%; p = 0.176), and at 24 months (six studies; OR: 0.86; 95% CI: 0.32-2.29; I2 = 74.9%; p = 0.764). No significant differences in terms of primary assisted patency, secondary patency, and postoperative complications were detected between the groups. More specifically, wound infection (BVTT: n = 9/150; BVET: n = 6/186; OR: 1.39; 95% CI: 0.48-4.06; I2 = 0%; p = 0.542) and healing of the scar, particularly regarding arm edema (BVTT: n = 18/100; BVET: n = 27/165; OR: 1.11; 95% CI: 0.57-2.18; I2 = 0%; p = 0.755) and hematoma formation (BVTT: n = 14/173; BVET: n = 42/209; OR: 0.40; 95% CI: 0.13-1.19; I2 = 49%; p = 0.101), did not differ significantly between the two study groups. BVET achieved superior primary patency at 6 months compared to BVTT, but this benefit seems to be lost during longer follow-up intervals. Therefore, both surgical techniques provide similar long-term outcomes.
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Affiliation(s)
- Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Aristotle University Medical School, Hippokratio Hospital, Thessaloniki, Greece
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Alex Houser
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Christos Karkos
- Vascular Unit, 5th Department of Surgery, Aristotle University Medical School, Hippokratio Hospital, Thessaloniki, Greece
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Department of Vascular and Endovascular Surgery, St Francis Hospital & Heart Center, Roslyn, NY, USA
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Yoo YS. Surgical management of a giant venous aneurysm in an autogenous arteriovenous fistula with the vessel loop shoelace technique for wound closure: A case report. Medicine (Baltimore) 2021; 100:e28072. [PMID: 35049230 PMCID: PMC9191326 DOI: 10.1097/md.0000000000028072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Giant venous aneurysm (GVA) is a complication of chronic arteriovenous fistula (AVF). The risks of thrombosis, rupture, and massive hemorrhage increase with the increasing size of GVA; therefore, GVA requires treatment. However, the optimal timing and treatments are yet to be established. PATIENT CONCERNS A 51-year-old male patient who had been undergoing hemodialysis for 10 years using a left radio-cephalic AVF presented to the hospital with an enormous venous aneurysm. DIAGNOSIS Physical examination and ultrasound revealed a GVA in the AVF. INTERVENTION The aneurysm was resected, and autogenous AVF was concomitantly formed using the basilic vein. The large wound caused by the removed aneurysm defect was closed using the vessel loop shoelace technique. OUTCOMES The wound healed completely, and the patient has been undergoing hemodialysis using the autogenous AVF created during the surgery for 15 months since then. LESSONS Surgical treatment should be considered for symptomatic GVA. Concomitant aneurysm resection and autogenous AVF formation using the basilic vein may be performed, and the resulting large wound can be closed with the vessel loop shoelace technique to facilitate healing.
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Li YS, Ko PJ, Hsieh HC, Su TW, Wei WC. Elevation transposition method for superficialization of the basilic vein achieves better patency rate than tunnel transposition. Ann Vasc Surg 2021; 80:113-119. [PMID: 34687887 DOI: 10.1016/j.avsg.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the tunnel transposition and elevation transposition methods used for superficialization of the basilic vein in terms of complication and patency rates. METHODS This retrospective study included patients who underwent two-stage basilic vein transposition between August 2016 and December 2019. Patients were categorized into brachial-basilic fistula tunnel transposition (n=32) and elevation transposition (n=21) groups using medical records. Primary patency was defined as a conduit that remains patent without any re-intervention to maintain patency. Primary assisted patency was defined as a conduit that has undergone intervention to maintain patency but has never been thrombosed. RESULTS The distribution of baseline characteristics was similar between the two groups. Coronary artery disease was the only variable that was significantly different between the tunnel transposition and elevation transposition groups (31.1% vs. 4.8%, p=.035). The tunnel transposition group had a greater amount of blood loss (p<.001) and a longer period of hospitalization (p=.002) than the elevation transposition group. The rates of suture repair to stop bleeding from the conduit was significantly different between the tunnel transposition and elevation transposition groups (31.8% vs. 4.8%, p=.035), whereas those of other complications were not significantly different. The elevation transposition group had a significantly higher primary patency rate than the tunneled transposition group (p=.033); however, primary assisted patency was achieved in all patients (100%) in both groups. CONCLUSION Elevation transposition might be a more reliable method than tunnel transposition for superficialization of a basilic venous fistula.
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Affiliation(s)
- Ying-Sheng Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
| | - Po-Jen Ko
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Hung-Chang Hsieh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Ta-Wei Su
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Wen-Cheng Wei
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
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Mehra K, Manikandan R, Dorairajan LN, Sreenivasan Kodakkattil S, Kalra S, Kumar R, Murali P. Outcomes of Transposition of Brachiobasilic Arteriovenous Fistula in Two-Stage Technique: A Single-Centre Experience With Literature Review. Cureus 2020; 12:e9949. [PMID: 32983655 PMCID: PMC7510181 DOI: 10.7759/cureus.9949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Arteriovenous fistulae (AVF) are considered a better option for long-term dialysis access. The distal radiocephalic AVF is the most preferred followed by proximal radiocephalic, brachiocephalic and brachiobasilic AVFs (BBAVF) with basilic vein transposition. In case of failure of AVF at other anatomical locations, BBAVF may improve the outcomes for patients needing dialysis for long term. The two-stage technique of BBAVF has easier dissection and lesser devascularisation risk. The disadvantages are need for two interventions and delay in maturation. Materials and Method It was a retrospective observational study including 42 patients who underwent transposition of BBAVF as two-stage procedure from June 2014 to July 2018. The data recorded were demographic characteristics, such as median age, gender, dialysis status at AVF creation and operative duration. Complications like postoperative limb oedema, bleeding and thrombosis of AVF were recorded. Patency and access outcome of AVF were documented at three-month follow-up. Results Among 42 patients, 27 (64.3%) were males. The median age was 50 years. Around 14% of patients had minor complications like oedema. Eight (19%) patients needed re-exploration due to bleeding or thrombosis. The early access failure rate that is a failure before discharge was 4.7%. The patency rate at three months was 90.5%, but the primary functional rate was 74%. Conclusion Transposition of BBAVF as a two-step technique is associated with reasonable patency rate and primary functional rate. The related complications were low, and a good number of fistulae could be saved with timely intervention.
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Affiliation(s)
- Ketan Mehra
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Ramanitharan Manikandan
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Lalgudi N Dorairajan
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
| | | | - Sidhartha Kalra
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
| | - Rajeev Kumar
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Padyala Murali
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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Uzun HA, Çiçek ÖF, Seren M. Transposition of basilic vein in forearm for arteriovenous fistula creation: Our mid-term results. Turk Gogus Kalp Damar Cerrahisi Derg 2019; 27:508-11. [PMID: 32082917 DOI: 10.5606/tgkdc.dergisi.2019.17600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to present our mid-term results of basilic vein transposition in the forearm to create an arteriovenous fistula. Methods Between January 2015 and October 2017, a total of 21 patients (13 males, 8 females; mean age 54.2±11.3 years; range, 32 to 74 years) with an adequate basilic vein and radial arterial systems who underwent basilic vein transposition in the forearm were retrospectively analyzed. All operations were performed under local anesthesia and mild sedation. The basilic vein was harvested using a single incision from elbow joint to wrist as an in situ vein graft. If the harvested basilic vein did not extend easily to the radial artery in the wrist region, the saphenous vein was harvested to extend arteriovenous fistula tract. Results The mean follow-up was 25.3±9.8 (range, 2 to 32) months. All patients underwent arteriovenous access surgery using transposed basilic vein in the forearm. In all patients, except for two, transposed basilic vein in the forearm stayed patent during follow-up with a patency rate of 90.5%. The mean fistula maturation time was 45.2±10.7 (range, 28 to 59) days. Conclusion If cephalic vein diameters are too small for arteriovenous fistula creation, basilic vein system in the medial surface of the forearm may be considered a favorable option.
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Mallios A, Jennings W, Costanzo A, Boura B, Combes M. Upper arm basilic vein elevation as a solution for forearm ulnar-basilic arteriovenous fistulae with cannulation problems. J Vasc Access 2018; 20:321-324. [PMID: 30189772 DOI: 10.1177/1129729818798303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ulnar-basilic arteriovenous fistula is an alternative option when a radiocephalic arteriovenous fistula is not feasible. We review our technique of basilic vein transposition in the upper arm for difficult to puncture forearm ulnar-basilic non-transposed arteriovenous fistulae. TECHNICAL NOTE Three patients were referred for forearm ulnar-basilic arteriovenous fistulae with difficult cannulation where the forearm basilic vein was left in situ (non-transposed). Surgeon performed ultrasound examination confirmed a patent arteriovenous fistula with adequate diameter and flow, draining to the basilic vein in the forearm and into the upper arm. Recurrent new and resolving hematomas were present surrounding the forearm basilic vein resulting from difficult cannulation issues and problems maintaining needle position due the posterior-medial ulnar-basilic arteriovenous fistula position and mobility of the non-transposed forearm basilic vein. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. Although difficult, dialysis access had been continued in the forearm during a brief period and none required catheter placement. Reliable dialysis access was successfully initiated using the newly transposed basilic vein in the upper arm 3-4 weeks after the procedure, maintaining arterial inflow based on the original ulnar-basilic arteriovenous fistula anastomosis at the wrist. None of the patients required further interventions with follow-up of 8, 15, and 22 months.
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Affiliation(s)
- Alexandros Mallios
- 1 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
| | - William Jennings
- 2 Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK, USA
| | - Alessandro Costanzo
- 1 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Benoit Boura
- 1 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Myriam Combes
- 1 Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
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Abstract
As more than 320,000 patients are currently receiving hemodialysis treatment in Japan, the creation and maintenance of hemodialysis access is a major concern. The national guidelines recommend autogenous arteriovenous hemodialysis, and the brachial-basilic arteriovenous fistula has been the focus of attention, because the need for secondary, tertiary, or even more vascular access is growing. Although favorable results have been reported in terms of patency and access-related complication, this fistula involves various unsolved or controversial issues, with limitations including complex procedures, which might contribute to the lower prevalence at this point in Japan. This review addresses those issues and discusses the role of fistula in Japan.
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Affiliation(s)
- Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Osamu Sato
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Kusick J, Salamat J, Sanghvi K. Thrombolysis for pulmonary embolism using the superficial veins of the upper extremity. Catheter Cardiovasc Interv 2017; 90:996-999. [PMID: 28734084 DOI: 10.1002/ccd.27193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/11/2017] [Accepted: 06/08/2017] [Indexed: 11/08/2022]
Abstract
This report describes a novel approach of accessing the superficial veins of the upper extremity for the treatment of pulmonary emboli (PE) with an ultrasound enhanced thrombolytic infusion catheter. In a patient suffering from saddle PE and impending right heart failure, separate basilic and cephalic venous access sites in the right arm were utilized to insert EKOS EndoWave Infusion Catheter (EKOS Corporation, Bothell, WA) insertion in each pulmonary artery (PA). This technique could be advantageous, particularly for patients at high risk for access site complications and those unable to lie supine for prolonged duration of infusion therapy.
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Affiliation(s)
- Joseph Kusick
- Deborah Heart & Lung Center, Browns Mills, New Jersey
| | - Judd Salamat
- Deborah Heart & Lung Center, Browns Mills, New Jersey
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Novotný R, Slavíková M, Hlubocký J, Mitáš P, Hrubý J, Lindner J. Basilic Vein Transposition Used as a Tertiary Vascular Access for Hemodialysis: 15 Years of Experience. Open J Cardiovasc Surg 2016; 8:1-4. [PMID: 26848275 PMCID: PMC4737518 DOI: 10.4137/ojcs.s34837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/22/2015] [Accepted: 12/09/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The quality of the life in patients requiring long term hemodialysis is directly proportional to the long-term patency of their vascular access. Basilic vein transposition for vascular access (BAVA) represents a suitable option for creating a tertiary native vascular access for hemodialysis on the upper extremities for patients requiring long term hemodialysis. The purpose of the study is to compare BAVAs with arteriovenous grafts (AVG). METHOD Data collection was based on selecting all of the patients with BAVA created in the time period in between January 1996 and August 2011. A questionnaire was created and sent to the selected hemodialysis centers. The resulting set of data was statistically analyzed and evaluated. RESULTS In the time period between 1 January 1996 and August 2011, arteriovenous access for hemodialysis was created in 6754 patients (7203 procedures in total). Out of these patients, 175 BAVAs were created. Our patient database of those undergoing the BAVA procedure consisted of 98 females (56%) and 77 males (44%) with an average age of 64.5 years. The prevalence of diabetes mellitus was 60% (105 patients). Primary patency after 12 months was 68.8%, 24 months 59.7%, 36 months 53.8, 48 months 53.8%, and 60 months 50%. Primary assisted patency after 12 months was 89.9%, 24 months 84.6%, 36 months 77.8%, 48 months 77.9%, 60 months 70.8%. Secondary patency after 12 months was 89.4%, 24 months 86.9%, 36 months 81%, 48 months 78.9%, 60 months 75.7%. Twenty-nine BAVAs (16.5%) were obliterated. CONCLUSION Patients benefit from this type of procedure due to the longer patency of a native arteriovenous access, as well as a lower incidence of infectious complications.
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Affiliation(s)
- Róbert Novotný
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Slavíková
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Hlubocký
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Mitáš
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Hrubý
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Lindner
- Second Department of Cardiovascular Surgery, General Teaching Hospital, Prague, Czech Republic.; First Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
Superficial venous aneurysms are a very uncommon disease probably associated with thrombosis and recurrent pulmonary thromboembolisms. Surgical treatment is safe and is performed in symptomatic cases. Surgical repair of superficial venous aneurysms is a recommended treatment, and no postoperative complications usually occur. The aim of this study is to report our experience treating superficial venous aneurysms, because they can cause devastating consequences. Obviously, they should be surgically treated if they are symptomatic, but there exists the possibility of complications such as thromboembolic events; however, they are unpredictable. Thus, the only solution to remove the potential risk of developing pulmonary or other embolic events is prophylactic surgery and anticoagulant therapy, also in low-risk patients.
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Affiliation(s)
- Catena Spataro
- Department of Surgery and Medical-Surgical Specialities, O. U. General and Oncologic Surgery, Vittorio Emanuele University Hospital of Catania, University of Catania, Catania, Italy
| | - Marcello Donati
- Department of Surgery and Medical-Surgical Specialities, O. U. General and Oncologic Surgery, Vittorio Emanuele University Hospital of Catania, University of Catania, Catania, Italy
| | - Francesco Basile
- Department of Surgery and Medical-Surgical Specialities, O. U. General and Oncologic Surgery, Vittorio Emanuele University Hospital of Catania, University of Catania, Catania, Italy
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Sousa CN, Norton de Matos A, Rocha A, Almeida P, Xavier E. Brachial-cephalic fistula recovered with drainage for the basilic vein: Case report. Hemodial Int 2015; 20:E15-7. [PMID: 25950565 DOI: 10.1111/hdi.12310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vascular access is essential for the implementation of hemodialysis (HD). The arteriovenous fistula (AVF) can be constructed in various locations using various veins. However, the quality of the veins will influence the construction site, as well as the functioning of the AVF. Careful analysis of the vascular network allows options for the development of new fistulas presentations. We present and discuss the case of a woman aged 69 years in HD in which a brachial-cephalic fistula with drainage to basilic vein was created, through rotation of the cephalic vein on the forearm level. This kind of access serves to prolong the time spent dialyzing through native fistulae, with their reduced complications and greater cost-effectiveness.
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Affiliation(s)
- Clemente Neves Sousa
- Centro de Hemodiálise da Ordem S. Francisco, Porto, Portugal.,Escola Superior Enfermagem Porto (Nursing College Porto), Porto, Portugal
| | - António Norton de Matos
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Rocha
- Centro de Hemodiálise da Ordem S. Francisco, Porto, Portugal
| | - Paulo Almeida
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Centro Hospitalar do Porto, Porto, Portugal
| | - Eva Xavier
- Centro de Hemodiálise da Ordem S. Francisco, Porto, Portugal
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Kakkos SK, Tsolakis IA, Papadoulas SI, Lampropoulos GC, Papachristou EE, Christeas NC, Goumenos D, Lazarides MK. Randomized controlled trial comparing primary and staged basilic vein transposition. Front Surg 2015; 2:14. [PMID: 25973421 PMCID: PMC4413520 DOI: 10.3389/fsurg.2015.00014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/09/2015] [Indexed: 11/13/2022] Open
Abstract
Objective It is unclear if brachio-basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Our aim was to report on a randomized controlled trial comparing these two techniques. Methods Sixteen patients with a basilic vein ≥2.5 mm were randomized into primary transposed brachio-basilic vein (TBBV) fistula (n = 9) and staged TBBV fistula (n = 7). Patients with basilic veins enlarged by previous arteriovenous fistulas were excluded. Baseline characteristics of the two study groups, including vein size, were comparable (median basilic vein diameter 3.5 mm, range 2.8–4.1 mm). The staged group had a brachio-basilic vein fistula performed first followed by the transposition procedure performed at least 6 weeks later to allow the basilic vein to enlarge. TBBV fistula maturation at 10 weeks, primary, assisted-primary, and secondary patency were the primary outcome measures. Early failures were included in the calculation of patency rates. Results Transposed brachio-basilic vein fistula maturation rate after primary procedures (3/9, 33%) was lower compared to maturation rate after staged procedures (7/7, 100%, P = 0.011, Fisher’s exact test), which led to premature termination of the trial. Time to hemodialysis [median (interquartile range)] of primary and staged procedures was 54 (51.5–113.5) days and 97 (93–126) days, respectively (P = 0.16). One-year primary and assisted-primary patency rates of primary and staged procedures were equivalent (44 vs 57%, P = 0.76 and 44 vs 71%, P = 0.29, respectively); however, there was a trend toward a better 1-year secondary patency after staged procedures (86 vs 44% for primary procedures, P = 0.09). Conclusions Among candidates for TBBV fistula with a small basilic vein, staged transposition achieves higher maturation rates compared to primary procedures, a difference reflected in long-term secondary patency. Trial registration www.ClinicalTrials.gov, identifier NCT01274117.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | | | | | - Nikolaos C Christeas
- Department of Interventional Radiology, University Hospital of Patras , Patras , Greece
| | - Dimitrios Goumenos
- Department of Nephrology, University Hospital of Patras , Patras , Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, Democritus University Hospital , Alexandroupolis , Greece
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13
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Shibutani S, Obara H, Ono S, Kakefuda T, Kitagawa Y. Transposed brachiobasilic arteriovenous fistula. Ann Vasc Dis 2013; 6:164-8. [PMID: 23825496 DOI: 10.3400/avd.oa.13-00042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 11/13/2022] Open
Abstract
We performed transposed brachiobasilic arteriovenous fistula (TBBAVF) in 24 patients from January 2006 to August 2010. The operative time was 90-210 minutes (mean: 136 minutes). All patients had edema of an upper extremity and 2 patients had wound complications. Major complications were not seen. The primary patency rates at one and two years were 89.7% and 69.0%, respectively. The secondary patency rates at one and two years were 95.7% and 73.6%, respectively. TBBAVF has good primary and secondary patency rates with few severe complications. (English Translation of Jpn J Phlebology 2011; 22: 33-38.).
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Affiliation(s)
- Shintaro Shibutani
- Department of Vascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
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14
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Abstract
Radiocephalic (RC) fistulae remain the first choice access for hemodialysis. The antecubital fossa is recommended as the next site. However, for some patients a basilic vein can be used to create an arteriovenous (av) fistula. We report a series of patients where the forearm basilic vein served as an alternative conduit for secondary procedures. Over an 8-year period, 30 patients who had a failed RC fistula underwent a basilic vein transposition. The immediate results were satisfactory. All fistulas were successfully cannulated. Cumulative patency was 93% after 1 year, 78% after 2 years, and 55% after 3 years. No ischemic or infectious complications were noted during the study period. The use of the forearm basilic vein to create a native av fistula appears to be a good alternative to procedures in the antecubital fossa or upper arm, thus preserving more proximal veins for future use.
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Affiliation(s)
- Jerzy Glowinski
- 1Department of Vascular Surgery and Transplantology, Medical University, Bialystok, Poland
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